There are four circumstances in which health practitioners might need to act, again with reference to BJ Fogg.
High motivation and easy to do
Imagine a patient who presents with a typical history of some potentially life limiting pathology. Health professionals are highly motivated to act, not least because failure to respond in these circumstances is the commonest reason for litigation. The presentation of the problem can itself trigger the behaviour one might conceive as appropriate. Think of:
- Red light = stop
- Green light = go
There are several such ‘signals‘ in medicine:
What the practitioner senses (sight, hearing, touch)
Abnormal physiological sign- abnormal blood pressure, erratic pulse, rapid breathing.
Sign of pathology- abnormal heart sound, a lump or bump.
What patient says
I’m bleeding, I can’t swallow, I’m going deaf, I can’t see
Did you spot the sign in the picture above? The problem with this scenario is that the signs of symptoms do not always evoke the necessary response. It may be too subtle, it may be presented when the doctor is distracted or it may not be recognised. Unfortunately in some instances the condition may be life threatening and therefore it is critical that the ‘signal’ is reliable. Much effort is expended in training health practitioners to be able to respond when required, unfortunately this effort is rarely maintained beyond the initial years of training.
High motivation but hard to do
This relates to patients who could be offered a treatment that the health practitioner knows might help but is hard to provide in the particular circumstances. Imagine traveling abroad and wishing to communicate with someone who doesn’t speak your language. Or wanting to donate money to a charity and not having access to the means to do it.
The triggers to act in these circumstance are what Fogg has dubbed ‘facilitator triggers‘. Think of:
- “Tip jars” at the cash register
- “Add to cart”
- ” Click on this link”
There are several such ‘facilitators’ in medicine:
- In house referral cues
- Desk top protocols for prescribing unfamiliar drugs
- Charts with instructions from an expert
This trigger has to be available while the practitioner is consulting the patient. It has to be recognised as relevant to the patient concerned and it has to be reinforced by a good experience when it triggers the relevant action- usually a referral or prescription. The trigger both prompts and makes it easier to act.
Low motivation and easy to do
In these circumstances the practitioner is not motivated to do the action but it is easy to do and that behaviour is triggered by something that increases the motivation.
Think of littering.
In medicine this might include:
- Prescribing an expensive drug when cheaper alternatives are available
- Ordering unnecessary tests
- Ignoring warnings of potential drug interactions
There are several ‘spark triggers‘ for such behaviours in healthcare.
What the patient, their family or an expert say or are perceived to say
I demand /recommend this test / prescription / referral.
How the practitioner is feeling or even the time of day
Tired people will behave irrationally or even irresponsibly (e.g. littering)
What the practitioner believes at the time
- Promotional material from a pharmaceutical company- pens with company logos
In this case the focus is on removing these triggers or making it more difficult to act on the unhelpful trigger. Health care funders often seek solutions in this category. Occasionally a behaviour is desirable- e.g. referral to an NGO for support, in which case the trigger needs to be generated.
Low motivation and hard to do
When people believe they have nothing to gain from an action and they perceive that is it too difficult to respond the action cannot be triggered.
These circumstances are easy to recognise:
- Being invited to donate a large sum to a cause that does not resonate with your interests / values
- Spending time on an activity at great opportunity cost.
Several examples in healthcare include:
- Offered to do research when there is little or nothing to gain from being involved personally
- Being invited to specialise in a condition that rarely presents in practice.
- Asked to employ someone who does not generate value to the business / clinic / institution
Often innovators are urged to find triggers for this category. In the first instance those who wish to promote these behaviours fail to recognise /accept that the practitioner is not motivated and underestimate the cost to that practitioner. One answer may lie in reframing the issue so that either motivation or ability are improved and the behaviour is then more likely to be triggered. Another answer is to accept that it is not possible to for practitioners to do everything we might want them to do.
Picture by Debs